The tally board shows the vote total — 22 to 7 — as the Senate concurs with changes made to SB96, the GOP leadership-backed replacement for the voter-approved Medicaid expansion ballot initiative, at the Capitol in Salt Lake City on Monday, Feb. 11, 2019.

SALT LAKE CITY — The GOP leadership-backed replacement for the voter-approved full Medicaid expansion ballot initiative easily cleared its final legislative hurdle Monday and was signed into law by Gov. Gary Herbert a few hours later.

The Senate voted 22 to 7 to concur with changes made in the House last week to the more limited Medicaid expansion in SB96 amid protests from supporters of the initiative known as Proposition 3, sending the bill to the governor.

"I think we are doing the long-term, responsible thing," the sponsor of SB96, Sen. Allen Christensen, R-North Ogden, said earlier Monday before the bill's final passage, following about 20 minutes of debate in the Senate.

Steve Griffin

Sen. Allen Christensen, R-North Ogden, answers questions about SB96, the GOP leadership-backed replacement for the voter-approved Medicaid expansion ballot initiative, during discussion on the bill at the Capitol in Salt Lake City on Monday, Feb. 11, 2019. The Senate concurred, 22 to 7, to changes made in the House last week amid protests from supporters of Proposition 3, sending the bill to the governor for his action.

Herbert signed the bill during in a private ceremony in his office midafternoon, before a group that included Republican lawmakers and state officials, along with community and faith leaders.

The ceremony was closed to the news media and not announced publicly. The bill, which now includes what's being called a fallback plan that resembles Proposition 3, took effect as soon as it was signed into law.

Before signing the bill, the governor met with a small group of faith leaders to discuss the bill. Late last month, representatives of some 40 faiths added their names to a letter opposing efforts to "delay or limit" full Medicaid expansion.

The Right Rev. Scott B. Hayashi, bishop of the Episcopal Diocese of Utah, a Proposition 3 sponsor who signed that letter, said after meeting with the governor that SB96 "is significantly greater than (where) I feared we would be."

The Rev. Hayashi, who also attended the governor's bill signing, said he "would prefer, of course, the full expansion. And at the same time, I recognize the forces that were at play. So where we got to now, as opposed to a complete repeal, I'm very pleased."

Also at the bill signing was Matt Slonaker, executive director of the Utah Health Policy Project. Slonaker said while the bill is "not perfect," he wanted to recognize those working for Medicaid expansion and to protect Proposition 3 from repeal.

The House added the fallback plan Friday to the bill in case the needed federal approval fails to come through from Washington for the more limited Medicaid expansion called for in the original Senate bill.

In the Senate, Sen. Curt Bramble, R-Provo, compared the full Medicaid expansion passed by voters last November to someone wanting a Maserati when there's only money for a Ford, as a result of the 0.15 percent sales tax increase in Proposition 3.

"The challenge is, they didn't approve a large enough tax increase to do everything they wanted," Bramble said. He said if voters wanted full Medicaid expansion, they should have approved more money to pay for it.

Senate Minority Whip Luz Escamilla, D-Salt Lake City, said even if the "magical waivers" being sought from the federal government are granted, the state could still face lawsuits over trying to implement only partial expansion.

Escamilla said she is concerned lawmakers are "still not giving the people of Utah what they voted for" and expressed doubt that the limited expansion will be allowed to go forward.

Steve Griffin, Deseret News

Sen. Luz Escamilla, D-Salt Lake City, voices her concern about SB96, the GOP leadership-backed replacement for the voter-approved Medicaid expansion ballot initiative, during discussion on the bill at the Capitol in Salt Lake City on Monday, Feb. 11, 2019. The Senate concurred, 22 to 7, to changes made in the House last week amid protests from supporters of Proposition 3, sending the bill to the governor for his action.

Past efforts by Utah and other states to win federal approval for covering fewer people than full Medicaid expansion at the same federal-to-state funding match of 90 percent to 10 percent have been rejected.

But Christensen and others have said they believe the Trump administration is ready to act and the fallback plan adopted in the House won't have to be used. Christensen called the House's efforts an answer to "what if, what if."

Monday's Senate vote was the same as the first time the bill passed the chamber, with all six Democrats opposed along with a single Republican, Sen. Todd Weiler, R-Woods Cross.

Weiler did not speak on the floor Monday, but has said he previously voted against SB96 because Proposition 3 was approved in his Senate district.

A senator who tried unsuccessfully to run a bill repealing any Medicaid expansion, Sen. Jake Anderegg, R-Lehi, voted in favor of SB96 again Monday even though he was critical of the concept.

"I hate this bill," he said, describing it as "going to do some good things for people" but at a risk. "It is the first step to universal health care. So I'm going to fight that … by voting for a bill that stinks."

The new state plan for limited Medicaid expansion begins April 1, just as Proposition 3 would have.

But the bill extends Medicaid coverage for Utahns earning only up to 100 percent of the approximately $12,000 federal poverty rate — not up to 138 percent covered under the full expansion in Proposition 3.

Utahns earning between 100 percent and 138 percent of poverty have the option of buying federally subsidized insurance at what Christensen and others have said are rates below $30 a month.

SB96 also initially provides a federal-to-state funding match of 70 percent to 30 percent while needed waivers are sought from Washington for the higher 90-10 match available under full Medicaid expansion.

Steve Griffin, Deseret News

Sen. Jake Anderegg, R-Lehi, voices his concern about SB96, the GOP leadership-backed replacement for the voter-approved Medicaid expansion ballot initiative, during discussion on the bill at the Capitol in Salt Lake City on Monday, Feb. 11, 2019. The Senate concurred, 22 to 7, to changes made in the House last week amid protests from supporters of Proposition 3, sending the bill to the governor for his action.

The House added language to the Senate bill that reverts to full Medicaid expansion, with some modifications, if the waivers are not granted. The Senate's action Monday was to concur with that change.

"I look at it as absolutely fulfilling our responsibilities as a legislature. There was nothing personal about this thing," SB96's sponsor, Christensen, told the Deseret News before the vote. "We're just simply doing our job."

Christensen, the chairman of the Social Services Joint Appropriations Subcommittee, said members heard requests Monday for more than $200 million in new spending.

"People say, 'Why can't you spend an extra $100 million for Medicaid expansion?' I say, 'Fine, then all those other places don't get it then.' It's not like we're hoarding this money. We just have to put it where it's best spent."

Some proponents of Proposition 3 expressed disappointment.

"This is a dark day for democracy," said Andrew Roberts, spokesman for Utah Decides, the group behind Proposition 3. "State legislators turned their backs on voters and on families in need."

Roberts said as "special interests and politicians celebrate the success of their backroom deal, Utah families will be up late tonight knowing they just lost the ability to afford lifesaving care."

Senate President Stuart Adams, R-Layton, said voters had "significant input" on the issue. Adams said had voters not approved Proposition 3, many lawmakers would have not approved Medicaid expansion.

Lawmakers already took action in a special session last year to replace the medical marijuana initiative approved by voters. Adams said he expects work is already underway to make changes to the remaining proposition on the ballot.

That anti-gerrymandering proposition established an independent redistricting committee to recommend new boundaries for congressional, legislative and state school board seats based on the once-a-decade census.